Healthcare Provider Details

I. General information

NPI: 1437296225
Provider Name (Legal Business Name): DAVIS FAMILY DENTAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1002 MERIDIAN AVE
COZAD NE
69130-1757
US

IV. Provider business mailing address

PO BOX 248 1002 MERIDIAN AVENUE
COZAD NE
69130-0248
US

V. Phone/Fax

Practice location:
  • Phone: 308-784-3377
  • Fax: 308-784-3395
Mailing address:
  • Phone: 308-784-3377
  • Fax: 308-784-3395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TIMOTHY L DAVIS
Title or Position: OWNER
Credential:
Phone: 308-784-3377